The "obvious future," to my eyes, consists of those achievements in technology not barred by the known laws of physics and which lie that the end of paths already funded and commenced. The only uncertainty is when these achievements arrive, and whether they enjoy the popularity and demand needed for commercialization, widespread usage, and consequent improvement. The devil is in the detail - look at what came of visions of flying cars from the Gernsbeck 50s. Possible, plausible, presently existing, but still a curio rather than mass market of transport. Other achievements, such as the development of computing capacity, have far surpassed popular predictions, reshaping our lives and prospects along the way.
So to medicine, a technology like any other. Greatly increased healthy longevity and near-absolute control over disease is the obvious future of medicine. The laws of physics allow it, the research community is slowly turning to this goal, and all that scientists and medical engineers lack today is the necessary knowledge. The future of medicine is one of increasingly capable, fine-grained control over cells, biomolecules and genes - manipulation at these levels of detail will become ever more accurate and ever more automated. Some hints of that future:
Garage Biology and Open Source Biology: Twenty five years ago, kids flocked to computers, pushing the limits of what they could do. Similarly, the next generation of genetic engineers won't need laboratories or even PhD: they'll have laptops, cheap mail order DNA synthesis, and, thanks to Google and Wikipedia and open journals like PLOS Biology, access to mountains of free biological data. They'll work in basements, garages, and cafes, and they'll trade ideas and collaborate on genetic designs the same way open source programmers now write computer code. Keep in mind that it was only 30 years ago that a little company called Apple started out of a California garage.
Engineered biology is going to allow us to make and test drugs far faster than ever before, particularly if they are based on DNA, RNA (a chemical cousin), or molecules that can be made by cellular factories. Examples of synthetic drugs already include RNAi-based therapeutics, aptamers, gene therapies, custom viruses, hormones, and monoclonal antibodies. As biotechnology booms, expect the drug pipeline to get a lot fatter and for bio-products become cheaper. A billion dollars to create a drug? That's just ludicrous. Life is cheap. The lower limit of bio-drugs should be the price of a sneeze.
Immortality: Biogerontologist Aubrey de Grey argues that here's no absolute reason why biological machines should break down and die. Theoretically, bits and pieces that break down can be continually regenerated and replaced, like keeping a vintage car in showroom condition. As biological engineering becomes more powerful, expect a plethora of age modulation drugs and treatments to appear.
I view nanotechnology in the larger context of making our world physically programmable. Ultimately, this means that making individual atoms act and move exactly the way we like should be as simple as writing a computer program. As the physical world becomes more programmable, many problems of daily life, from fixing broken computer parts to keeping medical implants from corroding, should become more tractable.
In recent experiments, I showed that the dielectrophoretic effect could be used to position, test, and assemble nanoelectronic devices into larger circuits. Such dielectrophoretic manipulation undermines the “fat fingers” argument against atomically precise nanosystems since field enhancement allows force field precision smaller than an electrode tip. In a computational study, I predict that certain diamond surfaces can locally raise the melting temperature of ice above human body temperature. Such surfaces may be useful in resolving the defrosting problem of cryonics, since they may enable atomically precise manipulation, in vivo, of biomolecules using “tweezers” of high-temperature ice.
The biotechnology of 2007 is much akin to the computational technology of 1957. There is a great road ahead of us, and even the nearest visible waystations promise gains in longevity and health unlike any seen before.